Objective: We undertook a longitudinal study in rural Uganda to understand the association of food insecurity with morbidity and patterns of healthcare utilization among HIV-infected individuals enrolled in an antiretroviral therapy program.
Design: Longitudinal cohort study.
Methods: Participants were enrolled from the Uganda AIDS Rural Treatment Outcomes cohort, and underwent quarterly structured interviews and blood draws. The primary predictor was food insecurity measured by the validated Household Food Insecurity Access Scale. Primary outcomes included health-related quality of life measured by the validated Medical Outcomes Study-HIV Physical Health Summary (PHS), incident self-reported opportunistic infections, number of hospitalizations, and missed clinic visits. To estimate model parameters, we used the method of generalized estimating equations, adjusting for sociodemographic and clinical variables. Explanatory variables were lagged by 3 months to strengthen causal interpretations.
Results: Beginning in May 2007, 458 persons were followed for a median of 2.07 years, and 40% were severely food insecure at baseline. Severe food insecurity was associated with worse PHS, opportunistic infections, and increased hospitalizations (results were similar in concurrent and lagged models). Mild/moderate food insecurity was associated with missed clinic visits in concurrent models, whereas in lagged models, severe food insecurity was associated with reduced odds of missed clinic visits.
Conclusion: Based on the negative impact of food insecurity on morbidity and patterns of healthcare utilization among HIV-infected individuals, policies and programs that address food insecurity should be a critical component of HIV treatment programs worldwide.
aDivision of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco, San Francisco, California
bRobert Wood Johnson Health and Society Scholars Program, Harvard University, Cambridge, Massachusetts
cDepartment of Internal Medicine, University of Washington, Seattle; Seattle, Washington
dDepartment of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
eMbarara University of Science and Technology, Mbarara, Uganda
fMassachusetts General Hospital Center for Global Health, Ragon Institute of MGH, MIT and Harvard Medical School, Boston, Massachusetts
gDepartment of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
Correspondence to Sheri Weiser, MD, MPH, Division of HIV/AIDS, San Francisco General Hospital, POB 0874, UCSF, San Francisco, CA 94143, USA. Tel: +1 415 314 0665; fax: +1 415 869 5395; e-mail: Sheri.Weiser@ucsf.edu
Received 9 June, 2011
Revised 20 August, 2011
Accepted 1 September, 2011